Provider Demographics
NPI:1528071305
Name:MARSHALL FAMILY DENTISTRY
Entity type:Organization
Organization Name:MARSHALL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-629-8187
Mailing Address - Street 1:3443 TAMIAMI TRL
Mailing Address - Street 2:SUITE F
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8159
Mailing Address - Country:US
Mailing Address - Phone:941-629-8187
Mailing Address - Fax:941-629-2498
Practice Address - Street 1:3443 TAMIAMI TRL
Practice Address - Street 2:SUITE F
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8159
Practice Address - Country:US
Practice Address - Phone:941-629-8187
Practice Address - Fax:941-629-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00114851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty